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Rheumatology Flashcards

(54 cards)

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1
Q

Swan neck = hyperextension at PIP and flexion and DIP

A

Boutonnière = flexion at PIP and hyperextension at DIP

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2
Q

For RA diagnosis you need 4/7 of RF RISES?

A

R - rheumatoid factor
F -finger/ hand joint involvement

R - rheumatoid nodules
I - Involvement of 3 + joints 
S - Stiffness (early morning) 
E - Erosions/ decalcification of x-rayI
S- Symmetrical
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3
Q

Which bloods should you do in RA?

A 
WBC
ESR/ CRP
Auto- antibodies (Rh/ CCP)
Albumin (low = increasing disease severity)
Neutropenia is seen in Felty’s syndrome)
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4
Q

What are the 3 types of biological drugs used in RA?

A

IL-1 receptor antagonists e.g. Anakinra
TNF alpha antagonists e.g. etanercept
Cytotoxic e.g. azathioprine

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5
Q

Extra-articular RA

A 
Eyes = kerato-conjunctivitis sicca, episcleritis, scleritis
CVS = endocarditis, pericarditis, myocarditis
CNS = carpal tunnel, peripheral neuropathies
Respiratory = pulmonary nodules, bronchiolitis obliterates , pleural effusions
Skin = rheumatoid nodules
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6
Q

X-ray features of RA

A

Soft tissue swelling e.g. joint effusion, oedema, tenosynovitis
Osteoporosis
Joint space narrrowing
Erosions

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7
Q

Reiters syndrome = triad of…

A

Seronegative asymmetrical arthritis

Conjunctivitis

Urethritis

Treat with bed-rest, intra-articulation steroids and NSAIDs

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8
Q

To be diagnosed with lupus you need 4/7 of

ORDER HER ANA

A 
O - Oral ulcers 
R - rash (malar)
D - disorder rash
E - exaggerated photosensitivty
R - renal disease and raynauds

H - haematological abnormality (low lymphocytes, platelets and neutrophils)
I - immunological abnormality (low C3/ C4,
S - serositis

A - ANA (Anti- dsDNA, anti- Ro/ La)
N - neurological
A - arthralgia

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9
Q

Minor SLE = NSAIDs, hydroxychloroquine and low dose steroids

A

Major SLE = high dose steroids and immunosuppressants

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10
Q

What is Libyan-Sacks endocarditis?

A

A non-bacterial form of endocarditis which typically affects this mitral valve

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11
Q

APTT is increased in anti-phospholipid syndrome

Platelets may be low

A

Initially treated with aspirin

STart warfarin in VTE develops

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12
Q

Anti-centromere antibody

A

Limited systemic sclerosis

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13
Q

Anti-Scl70

A

Diffuse cutaneous systemic sclerosis

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14
Q

Systemic sclerosis is also called CREST syndrome - what are the features?

A 
C = calcinosis 
R = raynauds
E = oesophageal dysmotility 
S = sclerodactyly (thickening of skin on finders and hands)
T = telangiectasia
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15
Q

Early stage systemic sclerosis = treat with immunosuppressants

A

Late stage = treat with anti-fibrotics e.g. penicillamine

Don’t forget CCB e.g. nifidepine for raynauds

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16
Q

Psoriatic arthritis usually causes an asymmetrical arthritis with prominent axial skeleton involvement

A

DIP joints are often affected - unlike in RA

Rh and ANA -ve

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17
Q

Extra-spinal features of ank spon?

A

Anterior uveitis
Enthesitis - tendon involvement
Aortic regurgitation
Apical pulmonary fibrosis

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18
Q

Skin features of dermatomyositis

A

Helitrope rash
Periorbital oedema
Gottron’s papule (red, scaly patches on dorsum of hand) and periungul telangiectasia
Shawl sing

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19
Q

Immunology of dermatomyositis

A

High CK and ANA

Anti-Jo +ve

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20
Q

Sjogrens is associated with RhF, ANA, anti-Ro and anti-La. What are the complications?

A 
Pancreatitis
Nephrogenic DI
Renal tubular acidosis
Glomerulonephritis
Neuropathy
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21
Q

What is polyarteritis nodosa?

A
  • Necrotizing vasculitis of small and medium blood vessels
  • Rapid renal failure can occur, as well as weight loss, fever, malaise, myalgia, polyarthritis
  • livedo reticularis is common
  • Arteriography will show multiple small aneurysms
  • associated with HBV, HIV, CMV etc
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22
Q

PMR = proximal stiffness, ESR raised but power normal and CK normal

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A

Unlike polymyositis which causes high CK

23
Q

Wegners granulomatosis

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A
  • necrotizing granulomas in respiratory tract + kidneys
  • purpura, cough, bloody nasal discharge, haematuria
  • cANCA
24
Q

Young female with systemic illness and tenderness over palpable arteries + bruits. May be claudication pain….

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A

Takayasu arteritis
Large vessel vasculitis
Treat with steroids +/- immunosuppressant
Beware renovascular hypertension

25
Behçet’s disease is more common in Turkey. What are the features?
``` Recurrent aphthous stomatitis Sterile pustules at site of trauma Genital ulceration Large joint arthritis Intestinal ulceration Epididymitis Uveitis ``` Treat with steroids/ ciclosporin
26
Podagra
1st MCP - most commonly affected in gout
27
Don’t forget gouty tophi on the pinnae and hands and arthritis can be a feature of chronic gout
Treat with NSAID/ colchicine | Allopurinol to reduce recurrence
28
Positively bifringent crystals
Pseudogout Calcium pyrophospahte crystals Diabetes, hyperparathyroidism, haemochromatosis, hypothyroid etc are RF
29
Pagets typically affects the pelvis, lumbar spine, femur and skull. Pain, fractures and nerve compression
ALP is raised but Ca normal Treat with bisphosphonate such as aledronate for active disease and calcitonin for pain
30
Osteomalacia is defective bone mineralisation. It presents with bone pain and deformity + proximal myopathy. Bloods show Low Ca, phosphate and vit D with high ALP and PTH. Give some causes
Poor diet Malabsorption Chronic pancreatitis Chronic renal failure ‘Looser’s zone’ on bones e.g. femur
31
Marfan’s associated with dilated aortic sinuses or mitral valve prolapse. Pectus excavatim and arachnodactlyl. Which protein is mutated?
Fibrillation | Arachnodactyly means fingers and long and spider like
32
Osteopenia = T score -1 to -2.5
Osteoporosis T score | < -2.5
33
Think Still’s disease in a patient with a fever which worsens in the afternoon/ evening then improves each morning
There is usually gradually worsening joint pain and a rash (typically salmon pink) NSAIDs are mainstay of treatment
34
Remember there should be a dramatic response with steroids when treating PMR.
If there is not a sudden improvement then the diagnosis is probably not correct
35
What is the cause of visual loss in temporal arteritis?
Anterior ischaemic optic neuropathy Typically described as ‘large, dark shadow coming down’
36
1st line management of OA
Lifestyle | Paracetemol +/- topical NSAID (if hands/ knee affected)
37
Remember limited (central) systemic sclerosis = anti-centromere
Diffuse (spread) systemic sclerosis = Anto-Scl70
38
High impact exercise, Black ethnicity and late menopause are all protective against osteoporosis
Having RA is a risk factor, included in the FRAX tool
39
Sjogrens may be primary or secondary to RA/ SLE etc. What important complication should you be aware of?
Vastly increased risk of lymphoma
40
Offer allopurinol to all patient who present with acute gout
It should be started at least 2 week after gout has settles as if started to early it can precipitate other atacks BUT if patients are already taking allopurinol they should continue to take it - even if they have an acute attack
41
Bone protection for patient started on long -term steroids?
> 65 or previous fragility # = start aledronate + ensure adequate Ca/ Vit D <65 = do bone density scan and act accordingly
42
Bisphosphonates are associated with osteonecrosis of the jaw and atypical femoral shaft #
Also risk of oesophageal reactions such as ulcers
43
Management of Ank Spon?
Regular exercise therapy e.g. swimming Physio NSAIDs
44
5key features of anti-phospholipid syndrome
1) Prolonged APTT 2) Thrombocytopenia 3) Recurrent arterial/ venous thrombosis 4) Recurrent pregnancy loss 5) Livedo reticularis
45
Ank spon = all the A’s
``` Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendinitis AV node block Amyloidosis ```
46
Patient on leflonumide need their FBC, LFT and BP measure. Myelosupression and pneumonitis are important side effects
Very long half-life so women need effective contraception for at least 2years after treatment
47
Who is the classic patient affected by Takayasau vasculitis?
Large vessel vasculitis which affects Asian women aged <40 Affects brachial of the arch of aorta —> head/ arms pain/ symptoms
48
What is the commonest type of vasculitis?
Kawasaki
49
Fibrinoid necrosis and ‘string of beads’ on angiogram?
Polyarteritis nodosa Symptoms depend on location: Renal —> HT Mesenteric —> mesenteric Ischaemia etc
50
Buerger’s disease is notorious for causing...
Clots in the vessels supplying the fingers and toes —> ulcers and necrosis Usually young men who smoke
51
How do you differentiate between granulomatosis with polyangitis (Wegners) and microscopic polyangitis?
Microscopic polyangitis affects lungs and kidneys only (NOT NOSE). There are NO granuloma and it is p-ANCA Wegner’s is cANCA
52
p-ANCA
Churg Strauss or microscopic polyangitis was
53
What are the different types of psoriatic arthritis?
- distal psoriatic arthritis - psoriatic spondylitis - rheumatoid-like - arthritis mutilans - asymmetrical oligoarthritis
54
The lung has a dual blood supply from the:
- pulmonary arteries | - bronchial arteries

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